Basic Information
| Provider Information | |||||||||
| NPI: | 1144469339 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADERHOLD | ||||||||
| FirstName: | HERNDON | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 E MAIN ST | ||||||||
| Address2: | BOX 5598 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730715305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055736470 | ||||||||
| FaxNumber: | 4055736472 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 EAST MAIN STREET | ||||||||
| Address2: | 5598 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055736470 | ||||||||
| FaxNumber: | 4055736472 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2009 | ||||||||
| LastUpdateDate: | 02/11/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 15962 | OK | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.